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DocuSign Envelope ID:30CFBA21-DC65-423A-A674-7D24A692C6ED <br /> WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY WC 32 03 01 C <br /> (Ed. 01-14) <br /> NORTH CAROLINA AMENDED COVERAGE ENDORSEMENT <br /> This endorsement applies only to the insurance provided by the policy because North Carolina is shown in Item <br /> 3,A. of the Information Page. <br /> The Cancellation Condition of the policy is replaced by this Condition: <br /> D. Cancellation And Nonrenewal <br /> 1. You may cancel this policy. <br /> If you cancel this policy, you must mail or deliver advance written notice to us stating when the <br /> cancellation is to take effect. <br /> 2, We may cancel this policy. <br /> (a) If this policy has been in effect for fewer than 60 days and is not a renewal policy, we may cancel this <br /> policy for any reason by giving you at least 30 days prior written notice of cancellation and the reasons <br /> for cancellation by registered or certified mail, return receipt requested. <br /> (b) If this policy has been in effect for at least 60 days or is a renewal policy,we may not cancel this <br /> policy without your prior written consent, except for any one of the following reasons: <br /> (1) Nonpayment of premium in accordance with the policy terms. <br /> (2) An act or omission by you or your representative that constitutes material misrepresentation or <br /> nondisclosure of a material fact in obtaining the policy, continuing the policy, or presenting a <br /> claim under the policy. <br /> (3) Increased hazard or material change in the risk assumed that could not have been reasonably <br /> contemplated by you and us at the time of assumption of the risk. <br /> (4) Substantial breach of contractual duties, conditions, or warranties that materially affects the <br /> insurability of the risk. <br /> (5) A fraudulent act against us by you or your representative that materially affects the insurability of <br /> the risk, <br /> (6) Willful failure by you or your representative to institute reasonable loss control measures that <br /> materially affect the insurability of the risk after written notice by us, <br /> (7) Loss of facultative reinsurance or loss of or substantial changes in applicable reinsurance as <br /> provided in G.S. 58-41-30. <br /> (8) Your conviction of a crime arising our of acts that materially affect the insurability of the risk. <br /> (9) A determination by the Commissioner that the continuation of this policy would place us in <br /> violation of the laws of North Carolina. <br /> (10) You fail to meet the requirements contained in our corporate charter, articles of incorporation, or <br /> bylaws, when we are a company organized for the sole purpose of providing members of an <br /> organization with insurance coverage in North Carolina. <br /> (c) If we cancel for any of the reasons listed in paragraph (b),we must provide you with at least 15 days <br /> prior written notice of cancellation stating the precise reason for cancellation. We may provide this <br /> notice by registered or certified mail, return receipt requested, to you and any other person designated <br /> in the policy to receive notice of cancellation at the addresses shown in the policy or, if not Indicated <br /> in the policy, at the last known addresses. Whenever notice of cancellation is given by registered or <br /> certified mail, cancellation will not be effective unless and until that method is employed and <br /> completed. Notice of cancellation may also be given by any method permitted for service of process <br /> pursuant to Rule 4 of the North Carolina Rules of Civil Procedure. Failure to send notice as provided in <br /> this paragraph to any other person designated in the policy to receive notice of cancellation <br /> invalidates the cancellation only as to that other person's interest, <br /> (Ed.41-14) <br /> 0 2013 National Council on Compensation Insurance,Inc. 20 of 24 <br />